Summary Conjunctivitis is a common condition that causes the eye to become red, itchy and oozing. It is common in patients with atopic dermatitis (also called eczema), and in other allergic diseases, including asthma. Apart from allergies, conjunctivitis can also be caused by infections, chemicals, irritants, and other diseases. Dupilumab is a prescription medicine approved in the USA for people 12 years and older with moderate‐to‐severe AD uncontrolled by topical (applied to the skin) prescription medicines or who cannot use topical medicines, for adults in other countries whose AD is uncontrolled with existing therapies, and for people 12 years and older for maintenance treatment of moderate‐to‐severe asthma uncontrolled with their current medicines. Dupilumab blocks activity of specific substances that cause these allergic diseases. In most AD studies, more dupilumab‐treated patients had conjunctivitis than patients on placebo (dummy drug). To investigate this effect, the authors assessed rates, risk factors, severity, and outcomes of conjunctivitis in 11 dupilumab studies in AD, asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), and eosinophilic esophagitis (EoE). In 5 of 6 AD studies, dupilumab‐treated patients were more likely to get conjunctivitis than placebo‐treated patients. No conjunctivitis was confirmed to be caused by infection, and it does not seem to be allergic in nature. Patients who entered these studies with more severe AD or who previously had conjunctivitis were more likely to get conjunctivitis. In asthma and CRSwNP studies, conjunctivitis rates were less frequent for both dupilumab and placebo than in AD studies, and were similar for dupilumab and placebo. In the EoE study, nobody had conjunctivitis. In all studies, conjunctivitis was mostly mild to moderate; most cases recovered during the treatment period. Causes of conjunctivitis in dupilumab‐treated patients require further study.

Crisaborole ointment is not recommended for treatment of AD in pregnant women In our recent European Task Force on Atopic Dermatitis (ETFAD) position paper, treatment of parental atopic dermatitis (AD) during preconception, pregnancy and lactation period was recommended according to expert opinion. We utilized a 'safety first' approach, but for some medications, there is very little safety data available. In these instances, one must make use of sparse evidence from case reports and case series to deduct safety, but also rely on the number of years a medication has been on the market without being associated with teratogenicity. Evidence from animal studies, as well as clinical data from other indications than AD may further be helpful.We incorrectly stated that 'according to the label, crisaborole is contraindicated in pregnant females'. Crisaborole (EUCRISA) ointment is not licensed in the EU for any indication. In consequence, there is no summary of product characteristics (SMPC) of the European Medicines Agency (EMA) available for this drug.The US label states: 'There is no available data with EUCRISA in pregnant women to inform the drug-associated risk for major birth defects and miscarriage, and In animal reproduction studies, there were no adverse developmental effects observed with oral administration of crisaborole in pregnantrats and rabbits during organogenesis at doses up to 5 and 3 times, respectively, the maximum recommended human dose (MRHD).' Furthermore it states: 'There is no information available on the presence of EUCRISA in human milk, the effects of the drug on the breastfed infant, or the effects of the drug on milk production after topical application of EUCRISA to women who are breastfeeding. EUCRISA is systemically absorbed. The lack of clinical data during lactation precludes a clear determination of the risk of EUCRISA to a breastfed infant. Therefore, the developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for EUCRISA and any potential adverse effects on the breastfed infant from EUCRISA or from the underlying maternal condition.'In summary, we acknowledge and apologize for the misquotation regarding the US label. A corrected line would read:Crisaborole is not licensed for any indication in the EU. According to the US label, there is no available data with EUCRISA in pregnant women to inform the drug-associated risk for major birth defects and miscarriage. As there is still no data available on humans, the ETFAD recommends that, due to lack of experience with this drug during pregnancy, crisaborole ointment should not be used preconceptionally, in pregnancy or during lactation.

Borrelia burgdorferi is a major cause of morbidity in wooded area in western Europe and the eastern seaboard of the U.S.A. Diagnosis of late stage infection and associated disorders may be difficult and often requires an array of different diagnostic procedures. Here we report an 11-year-old girl with acrodermatitis chronica atrophicans affecting all four limbs and parts of the trunk. The diagnosis was made on the basis of clinical appearance, serological and histopathological findings, and the lesional detection of B. burgdorferi-specific gene segments by polymerase chain reaction. This very unusual, severe case illustrates that despite being a late manifestation of tick-borne B.burgdorferi infection, usually occurring in adults, acrodermatitis chronica atrophicans may already appear at a young age and may be characterized by extensive skin involvement.

ZusammenfassungDupilumab ist ein monoklonaler Antikörper, der an die gemeinsame α‑Kette des IL(Interleukin)-4- und IL-13-Rezeptors bindet und den Th(T-Helferzelle)2-Signalweg blockiert, der bei der Entstehung des atopischen Ekzems eine Schlüsselrolle spielt. Wir berichten über den Fall eines 40-jährigen Patienten, der nach 6 Wochen Dupilumab-Therapie eine histologisch gesicherte Psoriasis entwickelte. Das eigenmächtige, abrupte Absetzen der ungewöhnlichen, nicht leitliniengerechten oralen Steroidtherapie und die Blockade des Th2-Signalwegs durch Dupilumab dürften die entscheidenden Auslösefaktoren für die erstmalige Ausbildung der Psoriasis bei unserem Patienten gewesen sein.

A 33-year-old man presented with very itchy red papules on the back of his hands and forearms. These papules appeared about 90 min after he had cleaned his aquarium in which he kept native fish and watersnails. He had obtained the watersnails some weeks before from a nearby pond. Examination of water from the aquarium revealed cercariae. The clinical diagnosis of cercarial dermatitis was corroborated. Cercarial dermatitis has repeatedly been seen in swimmers but not in aquarists keeping fish in a home aquarium.